Abstract
STUDY OBJECTIVE: To determine the relative costs of prostheses and factors associated with changes in these cost rankings. DESIGN AND SETTING: Economic model using published data. MAIN RESULTS: The main cost drivers are current costs and revision rates. Expected revision costs are a small proportion of the expected total costs. There are few competitors to the "gold standard" Charnley in terms of total expected costs over 20 years. There is no monetary advantage in using higher cost prostheses in older patients even if they were to have lower revision rates. There may be a monetary case for using prostheses with higher costs and lower revision rates in younger patients. CONCLUSIONS: The most cost effective prosthesis in older patients is the Stanmore. The Charnley, Exeter Polished and Muller Straight Stem are marginally more costly than the Stanmore. The study inevitably lacks good data on survival for newer prostheses. This does not affect the ability to make choices for older patients. Data are needed, however, on survival of cemented prostheses for younger patients.
Full Text
The Full Text of this article is available as a PDF (110.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- August A. C., Aldam C. H., Pynsent P. B. The McKee-Farrar hip arthroplasty. A long-term study. J Bone Joint Surg Br. 1986 Aug;68(4):520–527. doi: 10.1302/0301-620X.68B4.3733823. [DOI] [PubMed] [Google Scholar]
- Briggs A., Sculpher M., Buxton M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ. 1994 Mar-Apr;3(2):95–104. doi: 10.1002/hec.4730030206. [DOI] [PubMed] [Google Scholar]
- Daellenbach H. G., Gillespie W. J., Crosbie P., Daellenbach U. S. Economic appraisal of new technology in the absence of survival data--the case of total hip replacement. Soc Sci Med. 1990;31(12):1287–1293. doi: 10.1016/0277-9536(90)90067-3. [DOI] [PubMed] [Google Scholar]
- Faulkner A., Kennedy L. G., Baxter K., Donovan J., Wilkinson M., Bevan G. Effectiveness of hip prostheses in primary total hip replacement: a critical review of evidence and an economic model. Health Technol Assess. 1998;2(6):1–133. [PubMed] [Google Scholar]
- Gillespie W. J., Pekarsky B., O'Connell D. L. Evaluation of new technologies for total hip replacement. Economic modelling and clinical trials. J Bone Joint Surg Br. 1995 Jul;77(4):528–533. [PubMed] [Google Scholar]
- Huiskes R. Failed innovation in total hip replacement. Diagnosis and proposals for a cure. Acta Orthop Scand. 1993 Dec;64(6):699–716. doi: 10.3109/17453679308994602. [DOI] [PubMed] [Google Scholar]
- Krahn M., Gafni A. Discounting in the economic evaluation of health care interventions. Med Care. 1993 May;31(5):403–418. doi: 10.1097/00005650-199305000-00003. [DOI] [PubMed] [Google Scholar]
- Malchau H., Herberts P., Ahnfelt L. Prognosis of total hip replacement in Sweden. Follow-up of 92,675 operations performed 1978-1990. Acta Orthop Scand. 1993 Oct;64(5):497–506. doi: 10.3109/17453679308993679. [DOI] [PubMed] [Google Scholar]
- Muirhead-Allwood S. K. Lessons of a hip failure. BMJ. 1998 Feb 28;316(7132):644–644. doi: 10.1136/bmj.316.7132.644. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Murray D. W., Carr A. J., Bulstrode C. J. Which primary total hip replacement? J Bone Joint Surg Br. 1995 Jul;77(4):520–527. [PubMed] [Google Scholar]
- Nizard R. S., Sedel L., Christel P., Meunier A., Soudry M., Witvoet J. Ten-year survivorship of cemented ceramic-ceramic total hip prosthesis. Clin Orthop Relat Res. 1992 Sep;(282):53–63. [PubMed] [Google Scholar]
- Pynsent P. B., Carter S. R., Bulstrode C. J. The total cost of hip-joint replacement; a model for purchasers. J Public Health Med. 1996 Jun;18(2):157–168. doi: 10.1093/oxfordjournals.pubmed.a024475. [DOI] [PubMed] [Google Scholar]
- Ritter M. A. The cemented acetabular component of a total hip replacement. All polyethylene versus metal backing. Clin Orthop Relat Res. 1995 Feb;(311):69–75. [PubMed] [Google Scholar]